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FIFA fails to address concussion problem head on

WINNIPEG, Manitoba – There was a recent skit on German television featuring members of that country's World Cup-winning team and it went something like this. Philipp Lahm, Manuel Neuer and Thomas Muller, three

FIFA fails to address concussion problem head on

USA TODAY Sports' Martin Rogers reports on the concussion crisis that continues to hover over the beautiful game.

Christoph Kramer of Germany lies on the pitch after a collision during the 2014 FIFA World Cup Brazil Final match between Germany and Argentina at Maracana on July 13, 2014 in Rio de Janeiro.(Photo: Laurence Griffiths, Getty Images)

WINNIPEG – There was a recent skit on German television featuring members of that country's World Cup-winning team and it went something like this.

Philipp Lahm, Manuel Neuer and Thomas Muller, three of Germany's most influential players, appeared on a comedy to poke fun at their colleague Christoph Kramer.

Kramer's participation in last summer's World Cup final against Argentina, if you remember, lasted only 31 minutes after he received a ferocious accidental blow to the head, staggered to his feet confused and concussed, tried to continue, asked the referee if "this is really the World Cup final" and was eventually replaced.

On SportStudio months later, Neuer joked that Kramer asked if he could take over as goalkeeper. Lahm chortled that he thought Kramer was fine until his teammate tried to snatch away the captain's armband. Muller grinned as he jokingly stated that Kramer thought he had been transported back in time to 1974.

The stories were intended in jest. But amid all the hilarity it was also a chilling indication of the way soccer, even at the highest levels of the sport, treats head injuries and concussions with a profound lack of seriousness.

Fast forward to the current Women's World Cup and the issue of concussions remains a blind spot for FIFA, which usually appears to reserve its habit of looking the other way for actions of corruption and administrative greed.

The governing body congratulated itself last September for new proposals allowing referees to halt a game for three minutes if a brain injury is suspected, so a team doctor can perform an evaluation. The same doctor then decides if the player is fit to continue.

But such a small time frame, experts agree, is woefully insufficient to conduct a thorough inspection. Furthermore, it must be questioned as to whether a physician employed by the player's own team and thereby with a vested interest in their ability to carry on, is an appropriate person to be making that call.

Women, girls at higher risk

The injury to Kramer took place in the most-watched soccer match in history and appears to have been what prompted FIFA's action. Yet FIFA should be just as concerned with head injuries in the women's game. Studies claim female players could be twice as likely to become concussed, due to various medical factors.

"We hear about concussion a lot as a boys' problem, mostly because of (American) football," said Dr. Christopher Giza, a pediatric neurologist and sports concussion expert who directs UCLA's Steve Tisch BrainSPORT Program. "But in sports where the rules are the same, it turns out that women are actually at a higher risk.

"Women in general have smaller necks and smaller muscle mass. (They have) less strong neck muscles. The bigger the mass is, the harder it is to move. So when (a typical male head) gets hit there is less movement, you have less possibility for brain movement injury."

Giza said many athletes suffering from concussions hide their symptoms, either due to fear of losing their place on the team, a failure to understand the repercussions or pressure from parents or coaches to battle on.

Briana Scurry, the United States' World Cup winning goalkeeper from 1999, saw her career ended five years ago following complications from a concussion.

She experienced "intense, piercing headaches", as well as severe bouts of depression and anxiety.

"I felt disconnected from the world; from my friends, my family and my life," Scurry said. "I was able to block out 90,000 people and focus in 107-degree weather during the World Cup in 1999, in the final, but (post-concussion) I couldn't figure out where my car was."

Scurry underwent nerve release surgery last year that has improved her condition and has become a passionate and outspoken campaigner to raise awareness about the dangers of concussions. She wants to see changes in the sport, and believes situations where concussed players are allowed to continue participating in matches are "barbaric."

If it wished to, soccer's powers that be could implement various protective measures. Scurry favors a substitution rule specific to head injuries, whereby an affected player could be substituted for long enough to be analyzed properly, without the substitution counting toward the allotted number of three replacements.

Seeking solutions

A small but growing number of players wear various forms of protective headgear, including U.S. national team members Carli Lloyd and Ali Krieger.

The market leader is Full90, a San Diego-based firm that started in 2006 and sells a range of soccer-specific protective wear that is now fully authorized after initial hesitation from FIFA, and is particularly popular in youth soccer and among players who have suffered prior head trauma.

Full90's founder Jeff Skeen acted after his daughter suffered from concussions in youth soccer. "Some of the soccer organizations, they were just really against anything that highlighted the fact that so many head injuries were occurring in the sport of soccer," Skeen said. "It really dispelled the notion that soccer was a non-contact sport."

Skeen wants major companies like Nike or Under Armour to enter the soccer headgear market, pay the players they endorse to wear the products, which he believes would have the instant effect of turning the items into a fashionable must-have rather than "the sign of a wounded warrior."

Head injuries in soccer come in various guises. Kramer had the shoulder of rapidly-moving Argentinean Ezequiel Garay crash into his skull. Scurry was impacted by a rival's knee. Krieger was poleaxed during a National Women's Soccer League match by a head-to-head collision.

Soccer is also a sports outlier in that the skull is used as a means with which to strike the ball. According to Dr. Giza, a header in a training situation, controlled and with proper technique, should offer low risk for damage. In game situations however, with the ball coming from different angles and with players jostling for position, perfect contact cannot be guaranteed. Research into the effects of heading is ongoing.

The U.S. team doesn't need to look far to find an example of concussion problems. The squad for Scurry's last major tournament, the 2007 World Cup, included seven members of this year's group.

Current defensive back-up Lori Chalupny suffered a series of concussions that kept her off the national team for five years, before US Soccer medical experts were convinced she had recovered enough to be reinstated.

Former national team stars, including Brandi Chastain, have advocated banning players under the age of 14 from heading the ball, to reduce brain related injuries and impact.

But any change that requires an alteration to the laws of the game at the top level, such as mandating headgear, tinkering with the substitution rule, allowing for longer evaluation breaks, or limiting heading of the ball, faces a gross challenge to find its way into the laws of FIFA.

But if the sport's hierarchy expects its participants to use their heads in the pursuit of victory, it is too much to ask that they themselves use their own more effectively in the name of safety?

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